A nurse is caring for a client who requires protective isolation following a hematopoietic stem cell transplant. Which of the following interventions should the nurse implement to protect the client from infection?

A. Initiate cardiac monitoring
Cardiac monitoring is essential because the client has hyperkalemia (potassium 5.5 mEq/L), which increases the risk of life-threatening arrhythmias. Monitoring will help detect any cardiac changes during treatment, especially as potassium levels may fluctuate with insulin therapy and fluid resuscitation.
B. 0.9% sodium chloride at 15 mL/kg/hr for 1 hr and then reduce to 10 mL/kg/hr
Aggressive fluid resuscitation with isotonic saline is the cornerstone of DKA management to correct dehydration and improve perfusion. The initial rate of 15 mL/kg/hr is appropriate, given the client's signs of dehydration (slight tenting of skin, low blood pressure, and tachycardia). The reduction in rate after initial resuscitation prevents fluid overload.
C. Blood glucose checks every 4 hr
Frequent blood glucose monitoring (typically hourly) is required in DKA management, not every 4 hours, to closely monitor response to insulin therapy and adjust the infusion rate as needed.
D. Insert indwelling urinary catheter
While monitoring urine output is important, a catheter is not routinely indicated unless the client cannot void, is hemodynamically unstable, or requires strict measurement of output.
E. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L
Potassium replacement is anticipated but should be part of a protocol-based approach. Potassium is typically added to IV fluids once levels fall below 5.0 mEq/L and the client is voiding adequately.
F. Regular insulin 20 units subcutaneously
Subcutaneous insulin is not appropriate for managing DKA due to its delayed onset and prolonged action compared to IV insulin, which allows for precise titration.

G. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L
Continuous IV insulin is the standard treatment for DKA to reduce blood glucose levels and correct ketoacidosis. Insulin therapy should not begin until potassium is confirmed to be above 3.3 mEq/L to avoid exacerbating hypokalemia, which could lead to arrhythmias.

H. Dextrose 5% in water (D5W) intravenous at 5 mL/kg/hr for 4 hr
Dextrose-containing fluids are added only after blood glucose decreases to approximately 200-250 mg/dL to prevent hypoglycemia during ongoing insulin therapy. At this stage, D5W is not yet appropriate.

A. Clean surfaces with chlorhexidine is not appropriate for Clostridium difficile (C. difficile). The recommended cleaning agent for C. difficile spores is bleach, not chlorhexidine, as bleach is effective in killing the spores.

B. Place the client in a protective environment is not necessary for C. difficile. Protective environments are typically used for clients with immunocompromised states, such as those undergoing chemotherapy or bone marrow transplants, not for clients with C. difficile.

C. Wash hands with alcohol-based hand rub is not effective for C. difficile. Alcohol-based hand sanitizers do not kill C. difficile spores. The recommended method for hand hygiene is washing with soap and water to physically remove the spores.

D. Obtain a stool specimen with gloves is the correct action. When collecting a stool specimen from a client with C. difficile, gloves should always be worn to prevent transmission of the bacteria. C. difficile is highly contagious and requires strict infection control practices.